الفهرس 
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Abstract
This phase II prospective double-arm study carried out at Clinical Oncology Department Tanta University, Radiotherapy Department, NCI, Cairo University and Gharbia cancer society through the period from May 2018 to December 2019 and enrolled 67 patients with cervical and uterine carcinoma. The main objective of this study was evaluation of bone marrow sparing IMRT versus standard IMRT as a planning constraint in the treatment of cervical receiving concurrent chemo radiotherapy and evaluation of the toxicity profile and quality of life of both radiotherapy treatment modalities. Sixty Cervical cancer patients were divided into 2 groups: patients treated with standard IMRT (group A, n=32) and bone marrow sparing IMRT with constraint of Bone marrow was V20 <75%, V10 <90%, V40 <37%, mean <34.2Gy according to RTOG 0418 (Klopp et al 2013) defined as group B, n=28. There was no significant difference between both groups regarding age, performance, marital status, menopausal status, co morbidity, stage, operation status, grade of malignancy, Total dose of radiotherapy. All patients treated with concurrent chemoradiotherpy using weekly cisplatin 40 mg/m2 and IMRT with a dose of 45-50.4 Gy in 1.8-2 Gy/fraction IMRT used to deliver higher doses to reach to (55-60GY) to high-risk sites such as involved lymph nodes, residual and parametrial, using a sequential boost or SIB, followed by brachytherapy. Most of patients in both groups received 5 cycles of chemotherapy as 16 (50%) patients versus 23 (82.1%) patients in group A, B respectively with significant differences (p=0.009). There was statistically significant in favor of IMRT bone marrow sparing plans as decreased dose to organs at risk as total pelvic bone, its sub region (iliac, lumbosacral and lower pelvic) and bowel but lesser coverage to target volumes and higher dose to bladder and rectum in compared with standard IMRT plans. As regard early acute toxicity profile of patients, the most common acute hematological toxicity in both groups was neutropenia. Grade 3 neutropenia was 25% of patients in group A versus 0% in group B (p= 0.004). for non-hematological toxicity, Grade 1 diarrhea was 3.1% of patients in group A versus 39.3% in group B (p < 0.001), Grade 1 urinary toxicity was 0% of patients in group A versus 14.3% in group B (p =0.027). There wasn’t significant between both groups as regard late toxicity up to twelve months. As regard quality of life after one month of radiotherapy, there were significant improvement for physical function, fatigue, nausea& vomiting, diarrhea and symptom experience domain in IMRT bone sparing (group B). As regard quality of life after 4 months of radiotherapy, there were significant improvement for physical function, and fatigue in IMRT bone sparing. As regard quality of life after 12 months of radiotherapy, there weren‟t significant improvement for physical function, and fatigue in IMRT bone sparing. As regard the response of forty six cervical cancer patient treated with concurrent chemoradiotherapy and followed by brachytherapy , seven patients(15%) still had local residual tumor. Eight patients (17%) had distant metastases only, median time to metastases 15 months (range 3-31 months). Thirty one patients(67%) had no evidence of disease after a median follow-up of 24 months (range 13-60months).